| Sexually transmitted diseases (STDs) pose major threats, having both health and economic consequences in the United States. Our nation's response to the threat of STDs depends in large part upon state public health infrastructure. The primary responsibility for STD prevention rests with state and local health departments, although federal involvement has been significant.;Since 1948 the federal government has played a dominant role in the development and functioning of state STD programs. Historically, federal grants paired with the direct provision of operational support in the form of federal personnel have enhanced state STD programs and their ability to respond to newly emerging and ongoing threats of STDs. These federal personnel often comprised a preponderance of state STD program staff, and/or held a position of STD program leadership. As such, federal presence was expressed through the location of federal personnel in state STD program hierarchies, as well as through the proportion of federal personnel on the state STD program staff.;This federal presence raises questions such as: what are the policy and program consequences of the balance of power in STD public health? Does federal intervention have an impact on state policy and program capacity over time? The central question is one of state STD program autonomy given federal intervention.;This research examines the relationship between state STD program autonomy and federal variables through the application of Ellison's model of bureaucratic autonomy (1995) to a public health performance framework. Three contributions are made in the course of this research: (1) as yet, scholars have not investigated public health infrastructure with respect to a particular program, (2) an examination of the exogenous factors impacting public health infrastructure would be new in this field of study, and (3) the adaptation of Ellison's model to a program frame is new to research in federalism. |
